Tactics of procedures for patients with herpetic rashes on the face
Is herpes a consequence of procedures or activation of an infection in the body?
Current WHO statistics state that more than half of the population under 50 years of age is infected with herpes simplex virus type 1. Thus, the risk of activation of herpes infection after dermatocosmetological procedures is quite high. Let's look at the main treatment algorithms for this problem.
Ekaterina Maslak , dermatologist, cosmetologist, Center for Dermatology and Cosmetology of Professor Svyatenko, member of the Ukrainian Association of Dermatovenerologists and Cosmetologists
To be beautiful and have healthy skin is the main wish of every woman at an appointment with a dermatologist and cosmetologist. And today, medical cosmetology with incredible speed strives to make many dreams and desires of girls and women come true, so that their lives are not overshadowed by aesthetic problems and give pleasant emotions. Facial cleansing, hardware facial care procedures, lymphatic drainage and myofascial massage techniques, various peelings, mesotherapy and biorevitalization, contour plastic surgery, facial resurfacing, botulinum therapy - all this terminology is very familiar and understandable to us.
Exacerbation or complication?
Can the herpes simplex virus affect complications after various cosmetic procedures? When carrying out cosmetic procedures, most often with injection methods of administering drugs with hyaluronic acid, the nerve endings are damaged, and the herpes simplex virus spreads throughout the skin and covers different areas of the facial skin, and sometimes the entire face as a whole. In the first and second cases, a viral infection can be complicated by a bacterial one, which most often complicates diagnosis and can lead to the development of various complications and long-term treatment.
To reduce the risk of developing herpetic complications, there is a certain number of effective rules aimed at avoiding unpleasant incidents in the work of a dermatocosmetologist. It is important to consider that the herpes virus can cause both early and late complications after invasive procedures.
NB! During the period of exacerbation of herpetic infection, it is not recommended to carry out any cosmetic procedure.
In the first few days after the administration of a drug based on hyaluronic acid, activation of the virus may occur, which is manifested by blistering rashes characteristic of this disease in the area where the drug was administered. Most often, this clinical picture takes the form of grouped rashes against the background of hyperemia and swelling at the injection site. The differential diagnosis of this clinical picture does not cause any difficulties for a practicing dermatocosmetologist. If, when collecting an anamnesis, it turns out that the patient is prone to reactivation of herpes, it is recommended to prescribe antiviral drugs at least 2-3 days in advance to prevent its exacerbation, safety and prevention of unwanted reactions. And also take the drug on the day of the cosmetic procedure and for several days after it.
Reactivation of the virus will most often appear in the area where the filler was injected (the most common areas are the lips and nasolabial folds). In some cases, reactivation of the virus can spread and affect neighboring areas. An outbreak of the virus is usually observed 24-48 hours after the filler injection.
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Antiviral therapy as a method of prevention
There are a number of effective rules aimed at avoiding exacerbation of herpes in the practice of a dermatocosmetologist.
Treatment of symptomatic HSV depends on several antiviral drugs: acyclovir, valacyclovir hydrochloride. The current therapeutic approach can be divided into 3 groups:
- intermittent episodic therapy (IET);
- chronic suppressive therapy (CST);
- intermittent suppressive therapy (IST).
IET is used for acute episodes of chronic disease, CST is used for frequent relapses, and IST is used to prevent oral and genital herpes for short periods. Two treatment methods can be used simultaneously: ISI and IET. The first acts to prevent the reactivation of the virus, and the second is used in outbreaks of herpes diseases.
In cases of recurrent herpetic episodes caused by HSV (less than 3 reactivations per year), periodic episodic therapy with acyclovir 400 mg 3 times a day for 10 days is recommended before injections of hyaluronic acid fillers to correct the volume and asymmetry of the middle and lower third of the face. Alternatively, valaciclovir 1 g twice daily for 7 days can be used.
Intermittent episodic therapy is prescribed after filler injection in cases of HSV outbreak: acyclovir 400 mg 3 times a day for 10 days or 1 g valacyclovir hydrochloride 2 times a day for 7 days. To treat shingles, you can use 800 mg of acyclovir 5 times a day or 1 g of valacyclovir 2 times a day for 7 days.
In cases of frequent relapses and severe exacerbations, any procedure using hyaluronic acid fillers should be avoided and chronic suppressive therapy may be considered.
When collecting anamnesis, the dermatocosmetologist should always obtain accurate information from the patient, with an emphasis on past herpetic reactivations and previous cosmetic procedures. Proper clinical examination and strict monitoring after cosmetic injection procedures are necessary to prevent and effectively treat any herpetic outbreak.
Full version of the article in the magazine PRO Cosmetology by “Cosmetologist” No. 1, 2021